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General NPI Number Information
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NPI Number | 1144842543
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Entity Type | Individual
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Provider Name | KATHERINE MARIE COOK LAT, ATC
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Gender | Female
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Dates
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Enumeration Date | 05/08/2020
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Last Update Date | 05/08/2020
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Provider Practice Location Address
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Address Line | 215 GILBERT ST
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City | BLACKSBURG
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State | VA
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Zip | 24060-3305
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Country | US
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Telephone | 540-961-8061
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Fax |
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Provider Business Mailing Address
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Address Line | 5331 TWILIGHT RD
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City | ROANOKE
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State | VA
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Zip | 24019-2521
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 0126003044
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License Number State | VA
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